How to positively impact resident care and safeguard your communities’ future
Long-term care providers play a crucial role in ensuring the health of the elderly and others who have complex medical needs and require a high level of care. Value-based care (VBC) incentivizes healthcare providers to work together to improve patient health outcomes while reducing costs.
To accelerate the transition to VBC including Medicare Advantage, governments at the federal and state level are encouraging partnerships that enhance the ecosystem of care and technology.
A recent roundtable discussion sponsored by Curana Health and moderated by Kimberly Marselas, senior editor of McKnight’s Long-Term Care News, explored the potential reach of existing VBC partnerships, as well as the challenges and future of care delivery that aims to infuse the reimbursement system with a more holistic approach.
Participants offering insight were Jeremy Dressen, president and CEO of AllyAlign Health; Lynne Katzmann, partner at Perennial Advantage and founder/CEO of Juniper Communities; Amy Kaszak, executive vice president of strategic initiatives at Curana Health; Julie Kemman, CEO of Health Care Professional Consulting Services, Inc.; Lisa Leveque, vice president of strategic alignment and care transformation at Bandera Healthcare; Amy La Fleur, senior vice president of operations at Ciena Healthcare; Mark Price, CEO of Curana Health; and Paul Pruitt, CEO of Majestic Care.
Improving health outcomes
“[VBC] is fundamentally about creating an environment where everyone involved in caring for a patient is able to do the right thing for the right patient at the right time,” Price said. “If you do that, you produce good outcomes that create good outcomes for the organization as well.”
The push toward VBC has impacted hospitals and home care more than senior living and post-acute care facilities, La Fleur noted. “If you can put objective measures to execution, then it levels the playing field,” she said.
Ultimately, both VBC and long-term care are about promoting health.
“We want to capture the value that we create and be paid for what we did because it has a major impact on it,” Katzmann said.
When it comes to forming value-based partnerships, the industry has evolved from a position of begging for partners to being able to evaluate and choose among them, La Fleur said. As a result, Ciena Healthcare is restructuring the performance expectations of its medical directors and physicians.
“It’s a different mindset in VBC for nursing homes to be in the driver’s seat around that,” she explained.
Partnerships are a key component of successfully providing VBC.
“As we get into these relationships and we challenge our health plans in other states, we’re capable of getting creative with care,” Leveque said.
That will continue as the industry showcases VBC’s positive impact on beneficiaries through data. For now, many are rewarded for their ability to help residents and patients avoid hospitalizations or rehospitalizations.
“We have to be able to talk about outcomes in a way that everyone understands,” Katzmann said. “What you want to do is keep people healthy, and the best way that everyone knows how to measure that or can relate to it is by keeping people out of the hospital.”
Overcoming VBC challenges
Many long-term facilities now have hospitalist-trained physicians serving as managing physicians. However, long-term-care residents often require different services than other subsets, including geriatric services, comorbidities management and chronic care management, Leveque explained. As a result, facilities are relying more on specialists, which can create additional costs —or value.
Technology also can help reduce expenses and facilitate communication among caregivers.
“Performance management around VBC is much bigger than a transition from one level of care to another,” La Fleur said. “You have to be able to put into a practitioner’s hands what they need to look at.”
Unfortunately, most facilities use platforms that do not interact with one another, and existing platforms may not provide the exact data that partners want visibility into.
“There’s no one-stop shop,” Pruitt said. “We’re looking to hire our own person that can go in and build these reports. We want our destiny written by us, not somebody else out there that’s telling us how it’s going to work.”
Good data and technology, great training and support, and incentives are critical to VBC success, Price said. The entire staff must understand and be invested in the end goal.
“We make sure everybody, all of our physicians and nurse practitioners, are incentivized based on quality and all the communities we work in,” he said. “When you incentivize the community, amazing things happen.”
VBC is only as good as its relationships.
“We’ve taken the approach of developing a solution that’s going to meet where the operator or partner is at,” Dressen explained. “We bring to the table, ‘Here’s how you make a Medicare Advantage plan successful,’ but you need to help us know how we make it successful in your community.”
A VBC approach requires flexibility, integration and consistency, Kaszak added. It’s important to find a partner who is nimble and specializes in the industry, who can work with and understand the nuances of each level of the organization, and who has the size and scale to build a partnership that will continue to be of value as things evolve, she explained.
The future of VBC
“VBC is here to stay,” Kaszak said. “[CMS is] making it easier for more physicians to participate and they’re doubling down by backing up the accountable care organization (ACO) model with some baby managed-care steps for physicians who are not ready to be a part of an ACO, but can still participate in specific condition primary care models.”
With that more flexible model, Curana Health has been able to cover supplemental benefits from food delivery and on-site beauty services to cognitive therapy and companion care for residents in senior living, Dressen said. His advice: Think about how to drive value creation to expand the tenet of what encompasses VBC.
“We have to talk about our role in determining health,” added Katzmann, who found such value in the VBC approach that she jumped into the insurance business. “Good health saves money, good health means better quality of care and good health means happier consumers.”
Caring for those patients has evolved as the types of patients at long-term-care facilities have become significantly more complex over the years.
“We’re expected to care for our communities,” Leveque said. “We need to shift CMS to better understand the types of care that we’re being asked to provide.”
“It’s chronic care management, managing the person holistically through their life and understanding their whole life,” Pruitt added.
The ideal future of VBC is one in which everyone can focus on the right long-term plan for any individual resident to improve their health outcomes, Price concluded.
“If we had transparency and we had simplicity, and there was real money tied to a common scorecard everybody had around the country, it would unleash massive creativity and ability to go out and execute,” he said.